CGRP-pathway exposure during the pre-EBP interval in spontaneous intracranial hypotension: an exploratory retrospective case series
Abstract
Background: Given hypothesized involvement of calcitonin gene-related peptide (CGRP) in trigeminovascular pain and the frequent migrainous features of spontaneous intracranial hypotension (SIH), we describe temporal associations between initiation of CGRP-pathway therapies and short-term symptom changes during the interval before image-guided epidural blood patch (pre-EBP) in seven consecutively managed SIH patients. Because this is a small retrospective uncontrolled series, we report exploratory observations only.
Case presentation: Work-up included selective head-up tilt testing and heavily T2-weighted MR myelography demonstrating predominantly cervicothoracic and/or multifocal spinal CSF leaks. During the pre-EBP interval patients received CGRP-pathway agents: monoclonal antibodies (fremanezumab n = 1; galcanezumab n = 3) and/or gepants (atogepant n = 4; rimegepant PRN n = 1). Five of seven patients (71%) met a pre-specified rubric of clinically meaningful improvement documented after CGRP initiation; in all seven patients with routinely charted Numeric Rating Scale (NRS, 0-10) scores the median NRS reduction was 3 points (range 1-4). Positional orthostatic features commonly persisted until after EBP. Median interval from CGRP initiation to targeted EBP was 7 days. In this small cohort we did not observe an obvious signal that pre-EBP CGRP exposure impaired subsequent clinical response to EBP; however, the sample size and short follow-up preclude conclusions about rare or…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Calcium Ions in the Physiology and Pathology of the Central Nervous System
- AI-powered in silico twins: redefining precision medicine through simulation, personalization, and predictive healthcare
- In silico functional, structural and pathogenicity analysis of missense single nucleotide polymorphisms in human MCM6 gene
- In Silico drug repurposing pipeline using deep learning and structure based approaches in epilepsy
- Targeting serotonin receptors with phytochemicals – an in-silico study
- In silico exploration of anti-prostate cancer compounds from differential expressed genes
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.